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Ponce SEB, Small CJ, Ahmad T, Patel K, Tsai S, Kamgar M, George B, Kharofa JR, Saeed H, Dua KS, Clarke C, Aldakkak M, Evans DB, Christians K, Paulson ES, de Choudens SO, Erickson BA, Hall WA. Patterns of Locoregional Pancreatic Cancer Recurrence after Total Neoadjuvant Therapy and Implications on Optimal Neoadjuvant Radiation Treatment Volumes. Int J Radiat Oncol Biol Phys 2023; 117:e284-e285. [PMID: 37785058 DOI: 10.1016/j.ijrobp.2023.06.1270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
PURPOSE/OBJECTIVE(S) Neoadjuvant treatment for patients with localized pancreatic adenocarcinoma (PDAC) has improved survival duration. As survival increases, local disease control becomes even more important. We sought to understand the patterns of locoregional recurrence following total neoadjuvant therapy (TNT) and determine the impact of treatment volumes on recurrence. MATERIALS/METHODS Patients with PDAC managed with neoadjuvant chemotherapy and chemoradiation (TNT) followed by surgery who developed an isolated locoregional or simultaneously locoregional and distant recurrence were identified. Locoregional recurrences were individually contoured utilizing commercially available software. When available, original neoadjuvant dose distributions were registered to the scans on which the locoregional recurrences were contoured. Recurrences where then classified as in-field (> 95% of prescription dose), marginal (50-95% of prescription dose), or out of field (< 50% of prescription dose). Target volumes were created using four commonly utilized PDAC contouring guidelines to characterize the relationship of the local recurrence to the RT dose distribution. RESULTS Of 474 patients treated with TNT and surgery, 80 (17%) patients developed a locoregional recurrence with or without distant recurrence, visible on diagnostic imaging. Of the 80 patients, 56 (70%) had tumors in the pancreatic head; 46 (57.5%) were borderline resectable, 23 (28.8%) locally advanced, and 11 (13.6%) resectable. The most common initial neoadjuvant therapies were FOLFIRINOX (57.5%) and gemcitabine/nab-paclitaxel (18.8%). Chemoradiation included concurrent gemcitabine (47.5%) or 5-fluorouracil (26.3%). RT dose distributions were available for 38 patients; 22 (57.9%) had in-field failures, 9 (23.7%) marginal failures, and 7 (18.4%) out of field failures. Each published contouring atlas covered a relatively low percentage of recurrences, which are summarized in Table 1. Regions at particularly high likelihood of recurrence that were under covered on existing atlases included: aortic-diaphragmic junction, retro-pancreatic duodenal nodal basin, and the region to the right of the superior mesenteric artery (SMA). CONCLUSION We present the largest series (to our knowledge) of mapped locoregional recurrences for patients being treated with TNT in PDAC. These recurrences differ substantially from established atlases and highlight anatomical regions of highest priority for RT coverage. A novel visual contouring volume highlighting these regions will be presented which will strive to advance the use of RT in the TNT setting.
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Affiliation(s)
- S E Beltran Ponce
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - C J Small
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - T Ahmad
- Medical College of Wisconsin, Milwaukee, WI
| | - K Patel
- Medical College of Wisconsin, Milwaukee, WI
| | - S Tsai
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - M Kamgar
- Department of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - B George
- Department of Hematology and Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - J R Kharofa
- University of Cincinnati, Department of Radiation Oncology, University of Cincinnati Cancer Center, Cincinnati, OH
| | - H Saeed
- Lynn Cancer Institute, Boca Raton Regional Hospital, Baptist Health South Florida, Boca Raton, FL
| | - K S Dua
- Department of Gastroenterology, Medical College of Wisconsin, Milwaukee, WI
| | - C Clarke
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - M Aldakkak
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - D B Evans
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - K Christians
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - E S Paulson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - S Ortiz de Choudens
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI; Department of Radiation Oncology, Froedtert & the Medical College of Wisconsin, Milwaukee, WI
| | - B A Erickson
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
| | - W A Hall
- Department of Radiation Oncology, Medical College of Wisconsin, Milwaukee, WI
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Edinger JD, Wamboldt FS, Johnson RL, Simmons B, Tsai S, Morin CM, Holm KE. Adherence to behavioral recommendations of cognitive behavioral therapy for insomnia predicts medication use after a structured medication taper. J Clin Sleep Med 2023; 19:1495-1503. [PMID: 37086054 PMCID: PMC10394369 DOI: 10.5664/jcsm.10616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 03/31/2023] [Accepted: 03/31/2023] [Indexed: 04/23/2023]
Abstract
STUDY OBJECTIVES Cognitive behavioral therapy for insomnia (CBTI) has been paired with supervised medication tapering to help hypnotic-dependent individuals discontinue their hypnotics. This study examined the hypothesis that higher participant adherence to behavioral recommendations of CBTI will predict lower odds of using sleep medications 3 months after completion of a combined CBTI/sleep medication tapering protocol. METHODS Fifty-eight individuals who used sedative hypnotics completed four CBTI sessions followed by sleep medication tapering. Logistic regression was used to examine the association of stability of time in bed and stability of rise time (measured as the within-person standard deviation) at completion of CBTI with two outcomes at 3-month follow-up: use of sedative hypnotics and use of any medication/substance for sleep. RESULTS Participants with more stability in their rise time after CBTI than at baseline (ie, a decrease in their within-person standard deviation) had 69.5% lower odds of using sedative hypnotics at follow-up (odds ratio = 0.305, 95% confidence interval = 0.095-0.979, P = .046) than individuals who had no change or a decrease in the stability of their rise time. Results were similar for time in bed: participants with more stability in their time in bed after CBTI than at baseline had 83.2% lower odds of using sedative hypnotics (odds ratio = 0.168, 95% confidence interval = 0.049-0.580, P = .005). Increase in stability of rise time and stability of time in bed was also associated with reduced odds of using any medication/substance for sleep at follow-up. CONCLUSIONS Participants who implement behavioral recommendations of CBTI appear to have more success with discontinuing use of sleep medications. CLINICAL TRIAL REGISTRATION Registry: ClinicalTrials.gov; Name: The Role of Tapering Pace and Selected Traits on Hypnotic Discontinuation; URL: https://clinicaltrials.gov/ct2/show/NCT02831894; Identifier: NCT02831894. CITATION Edinger JD, Wamboldt FS, Johnson RL, et al. Adherence to behavioral recommendations of cognitive behavioral therapy for insomnia predicts medication use after a structured medication taper. J Clin Sleep Med. 2023;19(8):1495-1503.
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Affiliation(s)
- Jack D. Edinger
- National Jewish Health, Denver, Colorado
- Duke University Medical Center, Durham, North Carolina
| | | | | | | | | | | | - Kristen E. Holm
- National Jewish Health, Denver, Colorado
- Colorado School of Public Health, Denver, Colorado
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Thalji S, Aldakkak M, Christians K, Clarke C, George B, Kamgar M, Erickson B, Hall W, Chisholm P, Kulkarni N, Doucette S, Evans D, Tsai S. Neoadjuvant Chemotherapy for Pancreatic Cancer: Quality over Quantity. J Surg Oncol 2023. [PMID: 36960919 DOI: 10.1002/jso.27265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Revised: 02/19/2023] [Accepted: 02/26/2023] [Indexed: 03/25/2023]
Abstract
BACKGROUND AND OBJECTIVES The ideal duration of neoadjuvant chemotherapy (NACT) in patients with localized pancreatic adenocarcinoma (PDAC) treated with curative intent is unclear. We sought to determine the prognostic significance of both duration of NACT and Carbohydrate Antigen 19-9 (CA19-9) normalization to NACT. METHODS We examined patients with resectable and borderline resectable PDAC treated with NACT and chemoradiation. Patients were compared by NACT duration (2 vs 4 months) and by CA19-9 normalization after NACT. RESULTS Among 171 patients, 83 (49%) received two months of NACT and 88 (51%) received four months. After NACT completion, 115 (67%) patients had persistently elevated CA19-9 and 56 (33%) had normalized. Of the 125 patients who had successful surgery, 73 (58%) had normalized CA19-9 postoperatively. Duration of NACT was not associated with overall survival (OS) while CA19-9 normalization after NACT (regardless of duration) was associated with improved OS (HR 0.56, 95% CI 0.35-0.89, p=0.02). Adjuvant chemotherapy was associated with improved OS among patients without CA19-9 normalization after NACT (HR 0.42, CI 0.20-0.86, p=0.02) but not among those that normalized, independent of duration. CONCLUSIONS CA19-9 normalization after NACT is a clinically significant endpoint of treatment; patients without CA19-9 normalization may benefit from additional therapy. This article is protected by copyright. All rights reserved.
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Affiliation(s)
- Sz Thalji
- Department of Surgery, Division of Surgical Oncology, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - M Aldakkak
- Department of Surgery, Division of Surgical Oncology, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Kk Christians
- Department of Surgery, Division of Surgical Oncology, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Cn Clarke
- Department of Surgery, Division of Surgical Oncology, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - B George
- Department of Medicine, Division of Medical Oncology, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - M Kamgar
- Department of Medicine, Division of Medical Oncology, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Ba Erickson
- Department of Radiation Oncology, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Wa Hall
- Department of Radiation Oncology, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - P Chisholm
- Department of Medicine, Division of Gastroenterology, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - N Kulkarni
- Department of Radiology, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - S Doucette
- Department of Pathology, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - Db Evans
- Department of Surgery, Division of Surgical Oncology, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - S Tsai
- Department of Surgery, Division of Surgical Oncology, LaBahn Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
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Stout K, Adomako R, Almerstani M, Shin D, Tandon H, Schleifer J, Payne J, Easley A, Khan F, Windle J, Tsai S, Anderson D, Naksuk N. Prevalence of modifiable risk factors and related poor cardiovascular outcomes following atrial fibrillation ablation. Eur Heart J 2022. [DOI: 10.1093/eurheartj/ehac544.432] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Background
Atrial fibrillation (AF) has become a global epidemic. Early catheter ablation and therapies modifying risk factors (RF) have been shown to improve outcomes of AF ablation. However, the time invested in pursuing risk factor modification may delay ablation, which could negate the procedural benefit.
Purpose
This study sought to investigate the prevalence and impact of potentially modifiable RF among AF patients undergoing catheter ablation in clinical practice.
Methods
This retrospective study included 724 consecutive patients undergoing AF ablation at a tertiary care center from 2012–2019. Pre-specified modifiable risks were examined, including the time from AF diagnosis to ablation, fluctuation/increase in BMI >5% prior to ablation, mean systolic/diastolic blood pressure >125/80 mmHg, obstructive sleep apnea with CPAP noncompliance, hyperlipidemia without statin therapy, tobacco use, excessive alcohol use, and diabetes mellitus with hemoglobin A1c (HbA1c) >6.5%. The primary outcome was a composite of recurrent atrial arrhythmias, cardiovascular (CV) hospitalizations and mortality following AF ablation. A multivariate analysis was performed.
Results
The mean age was 61±10 years old, 32.5% were female and 72.2% had persistent AF. Many study patients had modifiable RF, ranging from 4.7% with excessive alcohol use to 64.0% experiencing delayed AF ablation. The mean time from AF diagnosis to ablation was 4.7 years. During a mean follow-up of 1.6 years after ablation, 467 (64.5%) patients met the primary outcome. Independent RF for the primary outcome were an increase/fluctuation in BMI >5% (adjusted hazard ratio [AHR] 1.31, 95% confidence interval [CI] 1.07–1.60; P=0.008), diabetes with HbA1c >6.5% (AHR 1.50, 95% CI 1.09–2.03; P=0.014) and hyperlipidemia without statin therapy (AHR 1.30, 95% CI 1.08–1.57; P=0.005). Delayed AF ablation over 1.5 years did not alter the outcome, Figure 1.
Conclusion
Substantial portions of patients undergoing AF ablation have potentially modifiable RF. Increased or fluctuating BMI, diabetes with HbA1c >6.5%, and hyperlipidemia not treated with statin therapy portend an increased risk of recurrent atrial arrhythmia, CV hospitalizations and mortality. These findings underscore an importance pursuing RF management in patients with AF to reduce adverse outcomes after ablation.
Funding Acknowledgement
Type of funding sources: Private grant(s) and/or Sponsorship. Main funding source(s): The Jensen Family Research Sponsorship at the University of Nebraska Medical Center
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Affiliation(s)
- K Stout
- University of Nebraska Medical Center , Omaha , United States of America
| | - R Adomako
- University of Nebraska Medical Center , Omaha , United States of America
| | - M Almerstani
- University of Nebraska Medical Center , Omaha , United States of America
| | - D Shin
- University of Nebraska Medical Center , Omaha , United States of America
| | - H Tandon
- University of Nebraska Medical Center , Omaha , United States of America
| | - J Schleifer
- University of Nebraska Medical Center , Omaha , United States of America
| | - J Payne
- University of Nebraska Medical Center , Omaha , United States of America
| | - A Easley
- University of Nebraska Medical Center , Omaha , United States of America
| | - F Khan
- University of Nebraska Medical Center , Omaha , United States of America
| | - J Windle
- University of Nebraska Medical Center , Omaha , United States of America
| | - S Tsai
- University of Nebraska Medical Center , Omaha , United States of America
| | - D Anderson
- University of Nebraska Medical Center , Omaha , United States of America
| | - N Naksuk
- University of Nebraska Medical Center , Omaha , United States of America
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Eldridge-Smith ED, Manber R, Tsai S, Kushida C, Simmons B, Johnson R, Horberg R, Depew A, Abraibesh A, Simpson N, Strand M, Espie CA, Edinger JD. Stepped care management of insomnia co-occurring with sleep apnea: the AIR study protocol. Trials 2022; 23:806. [PMID: 36153634 PMCID: PMC9509569 DOI: 10.1186/s13063-022-06753-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 09/14/2022] [Indexed: 11/10/2022] Open
Abstract
Background Obstructive sleep apnea (OSA) and insomnia are commonly co-occurring conditions that amplify morbidity and complicates the management of affected patients. Unfortunately, previous research provides limited guidance as to what constitutes the best and most practical management approach for this comorbid patient group. Some preliminary studies show that when cognitive behavioral insomnia therapy (CBT-I) is combined with standard OSA therapies for these patients, outcomes are improved. However, the dearth of trained providers capable of delivering CBT-I has long served as a pragmatic barrier to the widespread use of this therapy in clinical practice. The emergence of sophisticated online CBT-I (OCBT-I) programs could improve access, showing promising reductions in insomnia severity. Given its putative scalability and apparent efficacy, some have argued OCBT-I should represent a 1st-stage intervention in a broader stepped care model that allocates more intensive and less assessable therapist-delivered CBT-I (TCBT-I) only to those who show an inadequate response to lower intensity OCBT-I. However, the efficacy of OCBT-I as a 1st-stage therapy within a broader stepped care management strategy for insomnia comorbid with OSA has yet to be tested with comorbid OSA/insomnia patients. Methods/design This dual-site randomized clinical trial will use a Sequential Multiple Assignment Randomized Trial (SMART) design to test a stepped care model relative to standard positive airway pressure (PAP) therapy and determine if (1) augmentation of PAP therapy with OCBT-I improves short-term outcomes of comorbid OSA/insomnia and (2) providing a higher intensity 2nd-stage CBT-I to patients who show sub-optimal short-term outcomes with OCBT-I+PAP improves short and longer-term outcomes. After completing baseline assessment, the comorbid OSA/insomnia patients enrolled will be randomized to a 1st-stage therapy that includes usual care PAP + OCBT-I or UC (usual care PAP + sleep hygiene education). Insomnia will be reassessed after 8 weeks. OCBT-I recipients who meet “remission” criteria (defined as an Insomnia Severity Index score < 10) will continue PAP but will not be offered any additional insomnia intervention and will complete study outcome measures again after an additional 8 weeks and at 3 and 6 month follow-ups. OCBT-I recipients classified as “unremitted” after 8 weeks of treatment will be re-randomized to a 2nd-stage treatment consisting of continued, extended access to OCBT-I or a switch to TCBT-I. Those receiving the 2nd-stage intervention as well as the UC group will be reassessed after another 8 weeks and at 3- and 6-month follow-up time points. The primary outcome will be insomnia remission. Secondary outcomes will include subjective and objective sleep data, including sleep time, sleep efficiency, fatigue ratings, PAP adherence, sleepiness ratings, sleep/wake functioning ratings, and objective daytime alertness. Discussion This study will provide new information about optimal interventions for patients with comorbid OSA and insomnia to inform future clinical decision-making processes. Trial registration ClinicalTrials.gov, NCT03109210, registered on April 12, 2017, prospectively registered.
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Tsai S. The effects of lithium and inflammation on the atherosclerosis of older bipolar patients at high risk for cardiovascular disease. Eur Psychiatry 2022. [PMCID: PMC9564629 DOI: 10.1192/j.eurpsy.2022.1018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Atherosclerosis can result in serious cardiovascular disease (CVD) and is associated with inflammation and psychopharmacological treatment in bipolar disorder. Objectives We attempt to investigate the effects of lithium and inflammation on the atherosclerotic development in older bipolar adults at high risk for cardiovascular disease. Methods The euthymic out-patients with bipolar I disorder aged over 45 years and concurrent endocrine or cardiovascular disease were recruited to measure their bilateral carotid intima media thickness (CIMT) and circulating levels of lithium, valproate, sTNF-R1, sIL-6R, and lipid profile. All clinical information were obtained by directly interviewing patients and reviewing all medical records. Results Forty eight patients with mean 48.3 years old and mean 27.2 years of age at illness onset were recruited. After controlling for the body mass index, multivariate regression analyses showed that older age, lower lithium level, and higher plasma sTNF-R1 level were associated with higher CIMT and collectively accounting for 33.1% of the variance in CIMT. Blood level of low density lipid or valproate has none relationship with CIMT. Conclusions Lithium treatment may protect older bipolar patient, even those at high risk for CVD, from atherosclerotic development. Furthermore, persistent inflammatory activation, particularly macrophage activation, may be associated with the accelerating development of atherosclerosis. Disclosure No significant relationships.
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Edinger J, Manber R, Simmons B, Johnson R, Horberg R, Depew A, Abraibesh A, Simpson N, Eldridge-Smith ED, Strand M, Espie C, Kushida C, Tsai S. 0469 The Apnea and Insomnia Research (AIR) Trial: An Interim Report. Sleep 2022. [DOI: 10.1093/sleep/zsac079.466] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Many sleep apnea patients suffer from comorbid insomnia disorder. Although cognitive behavioral insomnia therapy (CBTI) has proven effective for insomnia among such patients, access to trained CBTI providers remains limited. The current study is testing a digital CBTI (dCBTI) among PAP-prescribed sleep apnea patients with comorbid insomnia.
Methods
Patients enrolled in this trial complete baseline measures and are randomized to dCBTI or sleep hygiene (CTRL). After 8 weeks, all patients are reassessed. Patients in the dCBTI arm who reach remission by this time point are offered no additional insomnia treatment, whereas those who do not achieve insomnia remission are randomly assigned either another 8 weeks of dCBTI or a therapist delivered CBTI (TCBTI). All groups are reassessed at the end of this second 8-week treatment phase and then again at 3- and 6-month follow-ups. This report considers changes in scores on the Insomnia Severity Index (ISI) from baseline to the end of the second 8-week treatment, as well as insomnia remission (ISI < 8) and responder rates (> 8 point decline on the ISI) of dCBTI and TCBTI relative to the CTRL. The sample for this report included the first 305 participants (mean age = 56.5±12.5 yrs.; 57.1% females).
Results
Both dCBTI and TCBTI recipients showed greater (p = .0001) and comparable reductions in ISI scores from baseline to the end of the second 8-week treatment phase than did those in the CTRL group. Average ISI score improvements moved dCBTI and TCBTI recipients from moderately severe to mild insomnia symptoms. Significant group differences were noted for both the responder (X2 (2) =19.29, p < 0.0001) and remission rates (X2 (2) =13.89, p = 0.001). Responder rates for those participants switched to TCBTI (50%) were noteably higher than those continued with dCBTI (30.5%) and those in the CTRL group (19.2%); but remission rates were comparable (30.5% vs. 29.2%) and sigificantly higher than the rates shown by the CTRL group (19.2%).
Conclusion
The dCBTI tested compares well with TCBTI for reducing insomnia symptoms and achieving insomnia remission in those with insomnia and sleep apnea, but insomnia responder rates may be improved by switching patients to TCBTI.
Support (If Any)
Funding support from the National Heart, Lung and Blood Institute, Grant # 1R01HL130559-01A1.
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Tandon H, Stout K, Shin D, Ruskamp R, Payne J, Goyal N, Tsai S, Easley A, Khan F, Windle J, Anderson D, Schleifer JW, Naksuk N. Pre-ablation interatrial conduction delay or block predicts atrial fibrillation recurrence after ablation among obese patients. Europace 2022. [DOI: 10.1093/europace/euac053.240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Funding Acknowledgements
Type of funding sources: None.
Background
Obesity is associated with greater risk of atrial fibrillation (AF) recurrence post-ablation and higher incidence of conduction delay compared to non-obese patients. Pre-ablation P-wave duration (PWD) and morphology (PWM) indicating interatrial delay are easily assessed in the clinic and may predict AF recurrence post-ablation in these patients.
Purpose
Evaluate the predictive value of PWD and PWM on AF recurrence post-ablation in obese patients.
Methods
Pre-ablation PWD and PWM (negative P-wave in lead II or III) were analyzed on consecutive patients with BMI ≥30 kg/m2 who underwent initial AF ablation from 2012–19. The primary outcome was recurrent AF after a 3-month post-ablation blanking period. Multivariate analysis adjusted for baseline characteristics was performed.
Results
For 205 patients (61.0±9.5 years old, 39.0% female), mean BMI was 36.9±5.7 kg/m2 and 71.7% had persistent AF pre-ablation. Recurrent AF post-ablation occurred in 115 (56.1%) during a median follow up of 491 (270, 1001) days. PWD >130 ms was significantly associated with higher AF recurrence (AHR of 1.62, 95%CI 1.04-2.57, p=0.03) after adjusting for age, persistent AF and left atrial volume index (LAVI). In a subgroup with LAVI <42 mL/m2 (n=112), PWD >130 ms and negative P-waves in lead II or III were independently associated with increased risk of recurrent AF (AHR 2.06, 95%CI 1.12-3.91; p=0.019 and AHR 1.94, 95% CI 1.00-3.56; p=0.05, respectively) (Figure 1).
Conclusion
AF recurred in >50% of obese patients within 1.5 years of ablation. Pre-ablation PWD >130 ms and negative P-waves in lead II or III independently predicted recurrent AF post-ablation in this cohort of obese patients. These easily assessed findings add predictive value to other risk factors.
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Affiliation(s)
- H Tandon
- University Of Nebraska Medical Center, Omaha, United States of America
| | - K Stout
- University Of Nebraska Medical Center, Omaha, United States of America
| | - D Shin
- University Of Nebraska Medical Center, Omaha, United States of America
| | - R Ruskamp
- University Of Nebraska Medical Center, Omaha, United States of America
| | - J Payne
- University Of Nebraska Medical Center, Omaha, United States of America
| | - N Goyal
- University Of Nebraska Medical Center, Omaha, United States of America
| | - S Tsai
- University Of Nebraska Medical Center, Omaha, United States of America
| | - A Easley
- University Of Nebraska Medical Center, Omaha, United States of America
| | - F Khan
- University Of Nebraska Medical Center, Omaha, United States of America
| | - J Windle
- University Of Nebraska Medical Center, Omaha, United States of America
| | - D Anderson
- University Of Nebraska Medical Center, Omaha, United States of America
| | - JW Schleifer
- University Of Nebraska Medical Center, Omaha, United States of America
| | - N Naksuk
- University Of Nebraska Medical Center, Omaha, United States of America
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AlMasri S, Zenati M, Hammad A, Singhi A, Paniccia A, Lee K, Aldakkak M, Evans D, Tsai S, Zureikat A, Ellsworth S. Implications of SMAD4 Status in Pancreatic Carcinoma Treated With Radiation Therapy: A Multi-Institutional Analysis. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Conger R, Mora J, Straza M, Erickson B, Lawton C, Schultz C, Currey A, Bedi M, Saeed H, Tsai S, Siker M, Hall W. Evolution in the Presence and Evidence Category of Radiation Therapy Treatment Recommendations in National Comprehensive Cancer Network (NCCN) Clinical Practice Guidelines in Oncology. Int J Radiat Oncol Biol Phys 2021. [DOI: 10.1016/j.ijrobp.2021.07.504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Stout K, Tandon H, Adomako R, Schleifer J, Payne J, Easley A, Khan F, Windle J, Tsai S, Anderson D, Peeraphatdit T, Naksuk N. Poor glycemic control in diabetic patients increases the risk of recurrent atrial arrhythmia and cardiovascular hospitalizations among morbidly obese patients undergoing atrial fibrillation ablation. Eur Heart J 2021. [DOI: 10.1093/eurheartj/ehab724.0513] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Background/Introduction
Obesity and atrial fibrillation (AF) coexist and share multiple cardiovascular risk factors. Lifestyle modifications can reduce AF burden in obese patients. However, the time invested in pursing lifestyle changes may delay AF ablation, which could negate the procedural benefit.
Purpose
To examine the effects of lifestyle modifications and the timing of catheter ablation on morbidly obese patients with AF.
Methods
This retrospective study included 217 consecutive AF patients with a body mass index (BMI) ≥35 kg/m2 undergoing AF ablation at a tertiary care center from 2012 to 2019. Modifiable risks were examined, including the time from AF diagnosis to ablation, fluctuation of BMI >5% or an increase in BMI >3% prior to ablation, mean systolic blood pressure >130 mmHg or diastolic blood pressure >80 mmHg, obstructive sleep apnea with CPAP noncompliance, hyperlipidemia without statin therapy, tobacco use, excessive alcohol use, and diabetes mellitus with hemoglobin A1c (HbA1c) ≥6.5%. The primary outcome was a composite of recurrent atrial arrhythmias and cardiovascular (CV) hospitalizations following AF ablation. A multivariate analysis adjusting for age, gender and modifiable risks was performed.
Results
The mean age was 61±9 years old, 58% were female and 45% had persistent AF. A substantial portion of the study patients had modifiable risk factors, ranging from 2.7% with excessive alcohol use to 67.3% experiencing delayed AF ablation, Figure 1. The median time from diagnosed AF to ablation was 1.3 years. During a mean follow-up of 2.9 years after AF ablation, 136 (62.7%) patients met the primary outcome. Only HbA1c ≥6.5% was an independent risk factor with adjusted hazard ratio of 1.57, 95% confidence interval 1.02–2.36, P=0.0412, Figure 2A. Delayed AF ablation did not alter the outcome, Figure 2B. There was no interaction between time of ablation and HbA1c ≥6.5% (P=0.67).
Conclusion
Substantial portions of morbidly obese patients undergoing AF ablation have potentially modifiable risk factors. Poor glycemic control with HbA1c ≥6.5% predicts an increased risk of recurrent atrial arrhythmias and CV hospitalizations, while delayed AF ablation does not. This finding underscores an importance of optimizing HbA1c in morbidly obese patients with AF to reduce adverse outcomes after ablation.
Funding Acknowledgement
Type of funding sources: None.
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Affiliation(s)
- K.M Stout
- University of Nebraska Medical Center, Cardiovascular Medicine, Omaha, United States of America
| | - H Tandon
- University of Nebraska Medical Center, Cardiovascular Medicine, Omaha, United States of America
| | - R Adomako
- University of Nebraska Medical Center, Cardiovascular Medicine, Omaha, United States of America
| | - J.W Schleifer
- University of Nebraska Medical Center, Cardiovascular Medicine, Omaha, United States of America
| | - J Payne
- University of Nebraska Medical Center, Cardiovascular Medicine, Omaha, United States of America
| | - A Easley
- University of Nebraska Medical Center, Cardiovascular Medicine, Omaha, United States of America
| | - F Khan
- University of Nebraska Medical Center, Cardiovascular Medicine, Omaha, United States of America
| | - J Windle
- University of Nebraska Medical Center, Cardiovascular Medicine, Omaha, United States of America
| | - S Tsai
- University of Nebraska Medical Center, Cardiovascular Medicine, Omaha, United States of America
| | - D Anderson
- University of Nebraska Medical Center, Cardiovascular Medicine, Omaha, United States of America
| | - T Peeraphatdit
- University of Nebraska Medical Center, Cardiovascular Medicine, Omaha, United States of America
| | - N Naksuk
- University of Nebraska Medical Center, Cardiovascular Medicine, Omaha, United States of America
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Edinger J, Wamboldt F, Holm K, Johnson R, Simmons B, Tsai S, Morin C. 364 Use of Blinded Hypnotic Tapering for Hypnotic Discontinuation: Final Report. Sleep 2021. [DOI: 10.1093/sleep/zsab072.363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Abstract
Introduction
Many patients have difficulties achieving hypnotic discontinuation due to anxiety that arises when they knowingly reduce their hypnotic dose or withhold it entirely. This study tested a blinded tapering approach to reduce patients’ anxiety and help them discontinue their hypnotics.
Methods
The study sample included 78 (M age = 55.2 ± 12.8 yrs.; 65.4% women) users of benzodiazepine and benzodiazepine receptor agonists. Following baseline assessments, enrollees first completed 4 sessions of cognitive behavioral insomnia therapy (CBTI). Subsequently they were randomized to one of three 20-week, double-blinded tapering protocols wherein their medication dosage either remained unchanged (CTRL) or was reduced by 25% or 10% every two weeks. At the end of the 20-week period the study blind was eliminated and those who completed one of the two blinded tapering protocols entered a 3-month follow-up period, whereas CTRL participants were offered an open label taper before completing the follow-up.
Results
Among those who completed one of the blinded tapering protocols, 92.9% totally discontinued their medication use by the end of the 20-week tapering phase, whereas 77.3% in the CTRL group discontinued hypnotic use by the end of their open label tapering. At follow-up 72.1% of those who completed blinded tapering remained medication free whereas only 52% of those who underwent open-label tapering remained medication free. Comparisons at follow-up showed those who received the open-label taper continued to use hypnotics on average 2.06 nights/week compared to .051 times per week for the blinded taper group (p = .042). The average weekly diazepam equivalent dose of medication used by the open label tapering group was 11.29 mg whereas the weekly dose for the blinded tapering group was 3.22 (p = .069).
Conclusion
CBTI combined with blinded hypnotic tapering is a promising treatment approach for helping hypnotic users overcome their medication dependence.
Support (if any)
National Institute of Drug Abuse, Grant # R34 DA042329-01
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13
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Harn H, Wang S, Lai Y, Van Handel B, Liang Y, Tsai S, Schiessl IM, Sarkar A, Xi H, Hughes M, Kaemmer S, Tang M, Peti-Peterdi J, Pyle A, Woolley T, Evseenko D, Jiang T, Chuong C. 609 Symmetry breaking of tissue mechanics in wound induced hair follicle regeneration. J Invest Dermatol 2021. [DOI: 10.1016/j.jid.2021.02.638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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14
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Nasief H, Hall W, Zheng C, Tsai S, Erickson B, Li A. A Multi-biomarker Panel Including Delta Radiomics to Predict Distant Metastasis after Chemoradiation Therapy of Pancreatic Adenocarcinoma. Int J Radiat Oncol Biol Phys 2020. [DOI: 10.1016/j.ijrobp.2020.07.2239] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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15
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Tsai S, Lee P, Gordon C, Cayanan E, Lee C. 0819 Objective Sleep Efficiency is Associated with Longitudinal Risk of High Depressive Symptoms in Pregnant Women. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Abstract
Introduction
Sleep disturbances are one of the most frequent complaints identified during routine prenatal care visits. Sleep and mood disturbances are often intertwined, and depression in particular is a leading cause of disability and disease burden worldwide. The purpose of this study was to examine the predictive association of objective actigraphic and subjective sleep disturbances with depressive symptoms in pregnant women.
Methods
We recruited 204 first-trimester pregnant women from a large university-affiliated hospital. They provided baseline socio-demographic and health information, wore a wrist actigraph for 7 days, and completed the Pittsburgh Sleep Quality Index and Center for Epidemiologic Studies - Depression Scale and repeated this again in the second and third trimesters. Each data collection was scheduled at least 8 weeks apart. Unadjusted and multivariable adjusted odds ratios with 95% confidence intervals were used to evaluate sleep disturbances at 1st trimester and risk of high depressive symptoms at follow-up.
Results
A total of 121 (59.3%) women had actigraphic sleep efficiency of < 85% and 92 (45.1%) had Pittsburgh Sleep Quality Index global scores > 5 indicative of poor sleep quality. In multivariable adjusted models, 1st trimester objectively measured sleep efficiency < 85% was associated with 2.65-, 3.86-, and 5.27-fold increased odds having risk of high depressive symptoms at 2nd trimester, 3rd trimester, and both 2nd and 3rd trimesters, respectively. No subjective sleep disturbance variables were significantly associated with risk of high depressive symptoms in multivariate adjusted models.
Conclusion
Objectively assessed poor sleep efficiency in the 1st trimester plays a crucial role in the development of both elevated and persistent high depressive symptoms in pregnancy. Future studies using objective sleep measurements and clinical diagnostic interviews are warranted to examine whether early interventions to improve sleep may help reduce high depressive symptom risk and lower depression rates in women during pregnancy.
Support
This study was funded by the Ministry of Science and Technology, Taiwan (MOST-101-2314-B-002-049-MY3).
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Affiliation(s)
- S Tsai
- National Taiwan University, Taipei, TAIWAN
| | - P Lee
- National Taiwan University Hospital, Taipei, TAIWAN
| | - C Gordon
- University of Sydney, Sydney, AUSTRALIA
| | - E Cayanan
- University of Sydney, Sydney, AUSTRALIA
| | - C Lee
- National Taiwan University, Taipei, TAIWAN
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Edinger JD, Walmboldt F, Holm K, Johnson RL, Simmons B, Tsai S, Morin C. 0509 Use of Blinded Hypnotic Tapering for Hypnotic Discontinuation. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Many patients have difficulties achieving hypnotic discontinuation due to anxiety that arises when they knowingly reduce their hypnotic dose or withhold it entirely. This study tested a blinded tapering approach to reduce patients’ anxiety and help them discontinue their hypnotics.
Methods
The study sample included 78 (M age = 55.2 ± 12.8 yrs.; 65.4% women) users of benzodiazepine and benzodiazepine receptor agonists. Following baseline assessments, enrollees first completed 4 sessions of cognitive behavioral insomnia therapy (CBTI). Subsequently they were randomized to one of three 20-week, double-blinded tapering protocols wherein their medication dosage either remained unchanged (CTRL) or was reduced by 25% or 10% every two weeks. At the end of the 20-week period the study blind was eliminated and those who completed one of the two blinded tapering protocols entered a 3-month follow-up period, whereas CTRL participants were offered an open label taper before completing the follow-up.
Results
Among those who completed one of the blinded tapering protocols, 92.9% totally discontinued their medication use by the end of the 20-week tapering phase, whereas 77.3% in the CTRL group discontinued hypnotic use by the end of their open label tapering. At follow-up 72.1% of those who completed blinded tapering remained medication free whereas only 52% of those who underwent open-label tapering remained medication free. Comparisons at follow-up showed those who received the open-label taper continued to use hypnotics on average 2-3 nights/week compared to about 1 time every other week for the blinded taper group (p = .05). The average weekly diazepam equivalent dose of medication used by the open label tapering group was about 5 times higher than the average weekly dose used by the blind tapering group (p = .025).
Conclusion
CBTI combined with blinded hypnotic tapering is a promising treatment approach for helping hypnotic users overcome their medication dependence.
Support
National Institute of Drug Abuse, Grant # R34 DA042329-01
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Affiliation(s)
- J D Edinger
- National Jewish Health, Denver, CO
- Duke University Medical Center, Durham, NC
| | | | - K Holm
- National Jewish Health, Denver, CO
| | | | | | - S Tsai
- National Jewish Health, Denver, CO
| | - C Morin
- Laval University, Quebec City, QC, CANADA
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Liao W, Lin S, Meng N, Tin H, Tsai S, Huang Y. 1134 Light Exposure At Daytime On Sleep Quality In Stroke Patient During Rehabilitation. Sleep 2020. [DOI: 10.1093/sleep/zsaa056.1128] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Abstract
Introduction
Lights maintain the day and night rhythm to set patients’ “wake-up cycle” and to stabilize their physiological functions, which may be expected to improve sleep. This study was aimed to investigate the relations between sleep quality and daytime light exposure in stroke patient during rehabilitation.
Methods
A cross-sectional study design was adopted and 120 stroke patients were recruited from rehabilitation wards of two medical centers and 116 patients completed this study. Research instruments including the Pittsburgh Sleep Quality Index, Epworth Sleepiness Scale, Sleep Log, and Somnowatch (Germany) for actigaphy sleep and light were used to collect data and urinary melatonin concentration were measured.
Results
47.4% of the patients had poor sleep quality (PSQI>5), 74.1% had actigraphic sleep efficiency less than 85%, and 90.5% waked more than 30 minutes after sleep onset. The average exposure time at lower level light (≤149 lux) were 288.8 minutes, accounting for 48% of the day (8:00-18:00). Compared to lower light exposure group (less than 319.5 min at >150 lux), those who exposed to higher level light (more than 319.5 min at >150 lux) had increased 52.1 minutes in actigraphic total sleep time (TST, t=-2.134, p=0.035), increased 8% in actigraphic sleep efficiency (SE, t=-2.053, p=0.042), and decreased 41.1 minutes in actigraphic wake-after-sleep-onset (WASO, t=2.209, p=0.029). Urinary melatonin concentration increased 52.7 pg/ml, but not statistically significant (t=-1.277, p=0.205). Result of multiple regression analysis showed that after controlling for age, gender, post-stroke complications, and environmental interference, time of bright light exposure significantly affected subjective sleep satisfaction (p=0.014), TST (p=0.04), SE (p=0.041), and WASO (p=0.026).
Conclusion
Increasing time of bright illumination (≥150 lux) during daytime may improve sleep quality. Results of this study provide empirical references for non-drug intervention to improve sleep quality in patients with stroke.
Support
This study was supported by the Ministry of Science and Technology, MOST 105-2628-B-040 -005 -MY2.
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Affiliation(s)
- W Liao
- China Medical University, Taichung, TAIWAN
| | - S Lin
- China Medical University Hospital, Taichung, TAIWAN
| | - N Meng
- China Medical University Hospital, Taichung, TAIWAN
| | - H Tin
- Chun Shan Medical University Hospital, Taichung, TAIWAN
| | - S Tsai
- Chun Shan Medical University Hospital, Taichung, TAIWAN
| | - Y Huang
- Chun Shan Medical University Hospital, Taichung, TAIWAN
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Tsai S, Pirruccio K, Ahn J. The brief window of time comprising a wheelchair transfer confers a significant fracture risk on elderly Americans. Public Health 2020; 182:1-6. [PMID: 32105994 DOI: 10.1016/j.puhe.2020.01.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2019] [Revised: 12/23/2019] [Accepted: 01/10/2020] [Indexed: 12/28/2022]
Abstract
OBJECTIVES Wheelchairs grant increased mobility to their users but can result in injuries of varying severities, including fractures which are often associated with wheelchair transfers. However, this fracture burden remains poorly characterized in elderly Americans. The purpose of this study was to report demographic and environmental risk factors for these injuries. STUDY DESIGN We used data from the National Electronic Injury Surveillance System (NEISS) for the years 2007-2017 to perform a retrospective, cross-sectional analysis of wheelchair transfer fractures in patients aged 65 years and older. METHODS Each yearly sample in the NEISS database was queried between 2007 and 2017 for fractures associated with wheelchair transfers in patients aged 65 years or older. The narrative sections of the database were individually read and reviewed to identify cases in which a patient explicitly transferred into or out of a wheelchair while sustaining said fracture. RESULTS Between 2007 and 2017, the average number of patients aged 65 years and older presenting to US emergency departments was 3924 (95% confidence interval [CI] = 2792-5055). A significantly higher percentage of fractures (61.8%; 95% CI = 56.7%-66.8%) is associated with transferring out of wheelchairs. Moreover, such fractures were often associated with transferring to and from beds (29.9%; 95% CI = 25.4%-34.3%), with the hip (37.5%; 95% CI = 33.3%-41.6%) being the most commonly fractured anatomical region overall. A majority of patients required admission to the hospital (60.2%; 95%CI = 52.4%-68.0%) and most wheelchair transfer fractures occurred at home (44.1%; 95% CI = 36.7%-51.5%), with women (71.9%; 95% CI = 68.3%-75.6%) comprising the majority of these patients. CONCLUSIONS Our findings show that wheelchair transfers are associated with significant risk of severe fracture in elderly Americans. As such, wheelchair transfer events merit extra attention from healthcare providers because they comprise a brief window of time relative to the number of occupancy hours in full-time wheelchair users yet can result in significant morbidity and mortality. Preventative measures and patient education should be encouraged to preserve patient mobility and reduce injury.
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Affiliation(s)
- S Tsai
- Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - K Pirruccio
- Perelman School of Medicine, University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
| | - J Ahn
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA.
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Nasief H, Erickson B, Hall W, Zheng C, Schott D, Aldakkak M, Tsai S, Wang L, Li A. Improving Treatment Response Prediction Using a Combination of Delta-Radiomics and Clinical Biomarker. Int J Radiat Oncol Biol Phys 2019. [DOI: 10.1016/j.ijrobp.2019.06.549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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20
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Morton-McCarthy K, Tsai S. 1031 The diagnostic impact of appropriately timed MSLT. Sleep 2019. [DOI: 10.1093/sleep/zsz069.1028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | - Sheila Tsai
- National Jewish Health, University of Colorado Department of Medicine
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21
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Edinger JD, Wamboldt F, Holm K, Johnson RL, Simmons B, Tsai S, Morin CM. 0408 A Blinded Hypnotic Tapering Approach for Hypnotic discontinuation. Sleep 2019. [DOI: 10.1093/sleep/zsz067.407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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22
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King N, Friedman J, Lin E, Traylor J, Wong J, Tsai S, Chaudhari A, Milad M. 102: Systematic review of major vascular injuries (MVI) during gynecologic lapraroscopy for benign indications. Am J Obstet Gynecol 2019. [DOI: 10.1016/j.ajog.2019.01.132] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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23
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Tsai S. Neuroendocrine Tumor Awareness Program in Taiwan. J Glob Oncol 2018. [DOI: 10.1200/jgo.18.20700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background and context: Neuroendocrine tumor (NET) is difficult to detect. It's often presented with symptoms common to other diseases. To raise awareness and improve the understanding of NET, the International Neuroendocrine Cancer Alliance (INCA) announced 10th November as the World NET Cancer Day. HOPE FOUNDATION for CANCER CARE has joined the advocacy events since 2011. Aim: To raise awareness and to improve the understanding of NET. Strategy/Tactics: To raise the awareness of the 10 symptoms of NET. To provide correct information about NET. To improve the understanding of NET. Program/Policy process: We held a series of campaigns in November 2017, including: theme decorations in 11 hospitals, 3 parades and shows at public places, a new animation with online marketing and outdoor advertising. By combining online and offline events, we have reached as many people as possible to increase the awareness and improve the knowledge of NET. We built the first as well as the only NET Mandarin Web site ( www.net.org.tw ) Outcomes: We cooperated with 11 hospitals in Taiwan to display educational posters and wall stickers. The information of NET cancers not only reached the public but also oncologists. This event had 3 newspaper reports and 16 online news reports. We conducted 3 educational parades and shows with zebra theme in three main cities in Taiwan. The parade in capital city Taipei gained total 86 reports including 71 online news media, 8 television channels and 7 newspapers. We cooperated with a celebrity artist to create a zebra mascot, which represents international symbol for NET. In addition, we created awareness lightbox advertising and animated video with the mascot to attract public attention and raise awareness of NET. This animated video was published on YouTube platform, and had 504,209 impressions and 208,427 views by 31st December 2017. Moreover, it was broadcasted on taxis in Taiwan as well. It was broadcasted 1,163,248 times during the promotion period. We also implemented an online advocacy plan through Facebook. This plan was designed with 4 posts, which contained a comic strip, an online memory game, a profile picture frame and an animated video. This plan totally had 332,625 impressions and reached 154,089 people on the Internet. What was learned: According to our experience with cancer patients, we realize that utilizing mascot characters to deliver educational information is more easily perceived by the public. This year we designed a new mascot of NET which was applied to animated video and outdoor advertising. Also, we conducted 3 educational parades with zebra theme and traditional Taiwanese features, which opened up a new dimension in advocacy for cancer awareness. Overall, these events received good response from the public and oncologists. The NET Mandarin Web site also showed a significant result with an increase of 98% of monthly page views and 69.7% of new visitors views.
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Khassawneh B, Bathgate C, Tsai S, Edinger J. 0434 Impact Of Short Sleep Duration And Hyperarousal On Cognitive Performance Among Individuals With Insomnia. Sleep 2018. [DOI: 10.1093/sleep/zsy061.433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
- B Khassawneh
- Department of Medicine, National Jewish Health, Denver, CO
- Faculty of Medicine, Jordan University of Science and Technology, Irbid, JORDAN
| | - C Bathgate
- Department of Medicine, National Jewish Health, Denver, CO
| | - S Tsai
- Department of Medicine, National Jewish Health, Denver, CO
| | - J Edinger
- Department of Medicine, National Jewish Health, Denver, CO
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25
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Edinger JD, Bathgate CJ, Tsai S. 0202 Daytime Hyperarousal Predicts Performance Deficits on Complex Tasks Among Insomnia Sufferers. Sleep 2018. [DOI: 10.1093/sleep/zsy061.201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Affiliation(s)
| | | | - S Tsai
- National Jewish Health, Denver, CO
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26
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Edinger JD, Wamboldt F, Holm K, Johnson RL, Simmons B, Tsai S, Morin CM. 0418 Blinded Hypnotic Tapering Promotes Hypnotic Discontinuation. Sleep 2018. [DOI: 10.1093/sleep/zsy061.417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | - K Holm
- National Jewish Health, Denver, CO
| | | | | | - S Tsai
- National Jewish Health, Denver, CO
| | - C M Morin
- Université Laval, Quebec City, QC, CANADA
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27
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Darling MR, Tsai S, Jackson-Boeters L, Daley TD, Diamandis EP. Human Kallikrein 3 (prostate-specific antigen) and Human Kallikrein 5 Expression in Salivary Gland Tumors. Int J Biol Markers 2018; 21:201-5. [PMID: 17177156 DOI: 10.1177/172460080602100401] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The human kallikrein 5 protein (hK5) is expressed in many normal tissues, most notably in skin, breast, salivary gland and esophagus. It has also been shown to be a potential biomarker for breast, ovarian and testicular cancer. Human kallikrein 3 (hK3; prostate-specific antigen) is the most useful marker for adenocarcinoma of the prostate gland. The aim of this study was to determine whether hK3 and hK5 are expressed in salivary gland tissues and salivary gland tumors (both benign and malignant), in order to compare normal with tumor tissues. Pleomorphic adenomas, adenoid cystic carcinomas, polymorphous low-grade adenocarcinomas, acinic cell carcinomas, mucoepidermoid carcinomas and adenocarcinomas not otherwise specified of both minor and major salivary glands were examined. The results of this study indicate that most salivary gland tumors do not show high levels of expression of hK5. Staining was most prominent in keratinizing epithelia in pleomorphic adenomas. hK3 is not expressed in salivary gland tumors.
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Affiliation(s)
- M R Darling
- Division of Oral Pathology, Department of Pathology, University of Western Ontario, London, Ontario N6A 5C1, Canada.
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28
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Edinger J, Walmboldt F, Holm K, Burleson A, Simmons B, Tsai S, Morin C. Use of blinded hypnotic tapering protocols to help medication-dependent insomnia patients discontinue their hypnotic use. Sleep Med 2017. [DOI: 10.1016/j.sleep.2017.11.252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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29
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Alvi F, Glaser L, Tolentino J, Chaudhari A, Milad M, Tsai S. Do Fibroids Reduce the Likelihood of Unanticipated Malignancy? J Minim Invasive Gynecol 2017. [DOI: 10.1016/j.jmig.2017.08.021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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30
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Saeed H, Cheng H, Aldakkak M, Tsai S, Evans D, Christians K, Thomas J, George B, Ritch P, Hall W, Erickson B, Wittmann D. Neoadjuvant Chemoradiation With IMRT for Pancreatic Cancer is Associated With Minimal Toxicity without Compromising Local Control. Int J Radiat Oncol Biol Phys 2017. [DOI: 10.1016/j.ijrobp.2017.06.1043] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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31
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Walter J, Xu S, Daly R, Tsai S. Systematic review of female fertility risk for breast cancer neoadjuvant/adjuvant therapies: implications for fertility preservation counseling. Fertil Steril 2017. [DOI: 10.1016/j.fertnstert.2017.07.537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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32
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Tsai S, Lee P, Lee C. 0818 SNORING AND BLOOD PRESSURE IN PREGNANT WOMEN. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.817] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Wang H, Tsai S. 0979 INFANT FEEDING AND NOCTURNAL SLEEP. Sleep 2017. [DOI: 10.1093/sleepj/zsx050.978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Rajamanickam ESP, Christians KK, Aldakkak M, Krepline AN, Ritch PS, George B, Erickson BA, Foley WD, Aburajab M, Evans DB, Tsai S. Poor Glycemic Control Is Associated with Failure to Complete Neoadjuvant Therapy and Surgery in Patients with Localized Pancreatic Cancer. J Gastrointest Surg 2017; 21:496-505. [PMID: 27896658 DOI: 10.1007/s11605-016-3319-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2016] [Accepted: 10/31/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND The impact of glycemic control in patients with pancreatic cancer treated with neoadjuvant therapy is unclear. METHODS Glycated hemoglobin (HbA1c) values were measured in patients with localized pancreatic cancer prior to any therapy (pretreatment) and after neoadjuvant therapy prior to surgery (preoperative). HbA1c levels greater than 6.5% were classified as abnormal. Patients were categorized based on the change in HbA1c levels from pretreatment to preoperative: GrpA, always normal; Gr B, worsened; GrpC, improved; and GrpD, always abnormal. RESULTS Pretreatment HbA1c levels were evaluable in 123 patients; there were 67 (55%) patients in GrpA, 8 (6%) in GrpB, 22 (18%) in GrpC, and 26 (21%) in GrpD. Of the 123 patients, 92 (75%) completed all intended therapy to include surgery; 57 (85%) patients in GrpA, 4 (50%) patients in GrpB, 16 (72%) patients in GrpC, and 15 (58%) patients in GrpD (p = 0.01). Elevated preoperative carbohydrate antigen 19-9 (CA19-9) (OR 0.22;[0.07-0.66]), borderline resectable (BLR) disease stage (OR 0.20;[0.01-0.45]) and abnormal preoperative HbA1c (OR 0.30;[0.11-0.90]) were negatively associated with completion of all intended therapy. Abnormal preoperative HbA1c was associated with a 2.74-fold increased odds of metastatic progression during neoadjuvant therapy (p = 0.08). CONCLUSIONS Elevated preoperative HbA1c is associated with failure to complete neoadjuvant therapy and surgery and a trend for increased risk of metastatic progression.
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Affiliation(s)
- E S Paul Rajamanickam
- Department of Surgery (Division of Surgical Oncology), Pancreatic Cancer Program, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI, 53226, USA
| | - K K Christians
- Department of Surgery (Division of Surgical Oncology), Pancreatic Cancer Program, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI, 53226, USA
| | - M Aldakkak
- Department of Surgery (Division of Surgical Oncology), Pancreatic Cancer Program, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI, 53226, USA
| | - A N Krepline
- Department of Surgery (Division of Surgical Oncology), Pancreatic Cancer Program, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI, 53226, USA
| | - P S Ritch
- Department of Medicine, Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - B George
- Department of Medicine, Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - B A Erickson
- Department of Radiation Oncology, Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - W D Foley
- Department of Radiology, Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - M Aburajab
- Department of Gastroenterology, Pancreatic Cancer Program, Medical College of Wisconsin, Milwaukee, WI, USA
| | - D B Evans
- Department of Surgery (Division of Surgical Oncology), Pancreatic Cancer Program, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI, 53226, USA
| | - S Tsai
- Department of Surgery (Division of Surgical Oncology), Pancreatic Cancer Program, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI, 53226, USA.
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Tsai S, Scott JF, Keller JJ, Gerstenblith MR. Cutaneous malignancies identified in an inpatient dermatology consultation service. Br J Dermatol 2017; 177:e116-e118. [PMID: 28231384 DOI: 10.1111/bjd.15401] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- S Tsai
- Department of Dermatology, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Lakeside 3500, 11100 Euclid Avenue, Cleveland, OH, 44106, U.S.A
| | - J F Scott
- Department of Dermatology, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Lakeside 3500, 11100 Euclid Avenue, Cleveland, OH, 44106, U.S.A
| | - J J Keller
- Department of Dermatology, Oregon Health & Science University, Portland, OR, U.S.A
| | - M R Gerstenblith
- Department of Dermatology, University Hospitals Cleveland Medical Center and Case Western Reserve University School of Medicine, Lakeside 3500, 11100 Euclid Avenue, Cleveland, OH, 44106, U.S.A
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Alvi FA, Matthews L, Tsai S, Chaudhari A. New Generation Mini-Laparoscopic Instruments in Common Gynecologic Procedures: A Demonstration of Feasibility in a Cadaveric Model. J Minim Invasive Gynecol 2016. [DOI: 10.1016/j.jmig.2016.08.543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Tsai S, Abdelhamid A, Khan MK, Elkarargy A, Widelitz RB, Chuong CM, Wu P. The Molecular Circuit Regulating Tooth Development in Crocodilians. J Dent Res 2016; 95:1501-1510. [PMID: 27872325 DOI: 10.1177/0022034516667724] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Alligators have robust regenerative potential for tooth renewal. In contrast, extant mammals can either renew their teeth once (diphyodont dentition, as found in humans) or not at all (monophyodont dentition, present in mice). Previously, the authors used multiple mitotic labeling to map putative stem cells in alligator dental laminae, which contain quiescent odontogenic progenitors. The authors demonstrated that alligator tooth cycle initiation is related to β-catenin/Wnt pathway activity in the dental lamina bulge. However, the molecular circuitry underlying the developmental progression of polyphyodont teeth remains elusive. Here, the authors used transcriptomic analyses to examine the additional molecular pathways related to the process of alligator tooth development. The authors collected juvenile alligator dental laminae at different developmental stages and performed RNA-seq. This data shows that Wnt, bone morphogenetic protein (BMP), and fibroblast growth factor (FGF) pathways are activated at the transition from pre-initiation stage (bud) to initiation stage (cap). Intriguingly, the activation of Wnt ligands, receptors and co-activators accompanies the inactivation of Wnt antagonists. In addition, the authors identified the molecular circuitry at different stages of tooth development. The authors conclude that multiple pathways are associated with specific stages of tooth development in the alligator. This data shows that Wnt pathway activation may play the most important role in the initiation of tooth development. This result may offer insight into ways to modulate the genetic controls involved in mammalian tooth renewal.
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Affiliation(s)
- S Tsai
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Ostrow School of Dentistry, University of Southern California, Los Angeles, CA, USA.,Graduate School of Clinical Dentistry, National Taiwan University, Taipei, Taiwan.,Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei, Taiwan
| | - A Abdelhamid
- Qassim College of Dentistry, Qassim University, Saudi Arabia
| | - M K Khan
- Qassim College of Dentistry, Qassim University, Saudi Arabia
| | - A Elkarargy
- Qassim College of Dentistry, Qassim University, Saudi Arabia
| | - R B Widelitz
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - C M Chuong
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Research Center for Developmental Biology and Regenerative Medicine, National Taiwan University, Taipei, Taiwan.,Integrative Stem Cell Center, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - P Wu
- Department of Pathology, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Hall W, Paulson E, Vistocky A, Tsai S, Koay E, Knechtges P, Evans D, Christians K, Ritch P, George B, Oshima K, Li A, Erickson B. Pancreatic Magnetic Resonance Imaging (MRI) and Computed Tomography (CT) Radiomic Metrics Correlate With Pathologic Molecular Markers: An Exploratory Analysis. Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Hall W, Lans D, Arce-Lara C, Kelley M, Santana-Davila R, Marcus D, Tsai S, Ridolfi T, Erickson B, Gore E. Outcome Analysis of Treatment in Stage IIA, T3N0 Rectal Adenocarcinoma in the Veterans Health Administration (VHA). Int J Radiat Oncol Biol Phys 2016. [DOI: 10.1016/j.ijrobp.2016.06.1058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mrkobrada M, Hill M, Chan M, Sigamani A, Cowan D, Kurz A, Sessler D, Jacka M, Graham M, Dasgupta M, Dunlop V, Emery D, Gulka I, Guyatt G, Heels-Ansdell D, Murkin J, Pettit S, Sahlas D, Sharma M, Sharma M, Srinathan S, St John P, Tsai S, Gelb A, O’Donnell M, Siu D, Chiu P, Sharath V, George A, Devereaux P. Covert stroke after non-cardiac surgery: a prospective cohort study. Br J Anaesth 2016; 117:191-7. [DOI: 10.1093/bja/aew179] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2016] [Indexed: 11/13/2022] Open
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Huang Y, Tsai S, Cheng Y, Lai C, Ku C, Lee Y. A Xeno-free Fibrinogen Depletion Method Support Scalable Expansion of Human Mesenchymal Stem Cell. Cytotherapy 2016. [DOI: 10.1016/j.jcyt.2016.03.241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
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Tsai S, Scott J, Keller J, Gerstenblith M. 641 Cutaneous malignancies identified by the Dermatology inpatient consult service. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.02.682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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43
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Tsai S, Arbesman J, Thompson C, Gerstenblith M. 601 Melanoma in pediatric, adolescent, and young adult patients: A nineteen-year retrospective analysis. J Invest Dermatol 2016. [DOI: 10.1016/j.jid.2016.02.641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Eskicioglu C, Forbes S, Tsai S, Francescutti V, Coates A, Grubac V, Sonnadara R, Simunovic M. Collaborative case conferences in rectal cancer: case series in a tertiary care centre. ACTA ACUST UNITED AC 2016; 23:e138-43. [PMID: 27122982 DOI: 10.3747/co.23.2894] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND In many hospitals, resource barriers preclude the use of preoperative multidisciplinary cancer conferences (mccs) for consecutive patients with cancer. Collaborative cancer conferences (cccs) are modified mccs that might overcome such barriers. METHODS We established a ccc at an academic tertiary care centre to review preoperative plans for patients with rectal cancer. Attendees included only surgeons who perform colorectal cancer procedures and a radiologist with expertise in cross-sectional imaging. Individual reviews began with the primary surgeon presenting the case information and initial treatment recommendations. Cross-sectional images were then reviewed, the case was discussed, and consensus on ccc-treatment recommendations was achieved. Outcomes for the present study were changes in treatment recommendations defined as "major" (that is, redirection of patient to preoperative radiation from straight-to-surgery or uncertain plan, or redirection of the patient to straight-to-surgery from preoperative radiation or plan uncertain) or as "minor" (that is, referral to a multidisciplinary cancer clinic, request additional tests, change type of neoadjuvant therapy, change type of surgery). Chart reviews provided relevant patient, tumour, and treatment information. RESULTS Between September 2011 and September 2012, 101 rectal cancer patients were discussed at a ccc. Of the 35 management plans (34.7%) that were changed as a result, 8 had major changes, and 27 had minor changes. Available patient and tumour factors did not predict for a change in treatment recommendation. CONCLUSIONS Preoperative cccs at a tertiary-care centre changed treatment recommendations for one third of patients with rectal cancer. Given that no specific factor predicted for a treatment plan change, it is likely prudent that all rectal cancer patients undergo some form of collaborative review.
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Affiliation(s)
- C Eskicioglu
- Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, ON
| | - S Forbes
- Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, ON
| | - S Tsai
- Department of Radiology, Faculty of Health Sciences, McMaster University, Hamilton, ON
| | - V Francescutti
- Department of Surgery, Roswell Park Cancer Institute, Buffalo, NY, U.S.A
| | - A Coates
- Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, ON
| | - V Grubac
- Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, ON
| | - R Sonnadara
- Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, ON
| | - M Simunovic
- Department of Surgery, Faculty of Health Sciences, McMaster University, Hamilton, ON;; Escarpment Cancer Research Institute, Hamilton Health Sciences and McMaster University, Hamilton, ON
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Schulte M, Tsai S, Riley J, Jungheim E. Female obesity is associated with complete failure to fertilize with conventional insemination. Fertil Steril 2015. [DOI: 10.1016/j.fertnstert.2015.07.371] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Yin N, Qi X, Tsai S, Lu Y, Basir Z, Oshima K, Thomas JP, Myers CR, Stoner G, Chen G. p38γ MAPK is required for inflammation-associated colon tumorigenesis. Oncogene 2015; 35:1039-48. [PMID: 25961922 DOI: 10.1038/onc.2015.158] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2014] [Revised: 03/03/2015] [Accepted: 03/10/2015] [Indexed: 12/22/2022]
Abstract
Chronic inflammation has long been considered to causatively link to colon cancer development. However, signal transduction pathways involved remain largely unidentified. Here, we report that p38γ mitogen-activated protein kinase mediates inflammatory signaling to promote colon tumorigenesis. Inflammation activates p38γ in mouse colon tissues and intestinal epithelial cell-specific p38γ knockout (KO) attenuates colitis and inhibits pro-inflammatory cytokine expression. Significantly, p38γ KO inhibits tumorigenesis in a colitis-associated mouse model. The specific p38γ pharmacological inhibitor pirfenidone also suppresses pro-inflammatory cytokine expression and colon tumorigenesis. The tumor-promoting activity of epithelial p38γ was further demonstrated by xenograft studies. In addition, p38γ is required for β-catenin/Wnt activities and p38γ stimulates Wnt transcription by phosphorylating β-catenin at Ser605. These results show that p38γ activation links inflammation and colon tumorigenesis. Targeting p38γ may be a novel strategy for colon cancer prevention and treatment.
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Affiliation(s)
- N Yin
- Department of Pharmacology and Toxicology, Medical College of Wisconsin, Milwaukee, MI, USA
| | - X Qi
- Department of Pharmacology and Toxicology, Medical College of Wisconsin, Milwaukee, MI, USA
| | - S Tsai
- Department of Surgery, Medical College of Wisconsin, Milwaukee, MI, USA
| | - Y Lu
- Department of Physiology, Medical College of Wisconsin, Milwaukee, MI, USA
| | - Z Basir
- Department of Pathology, Medical College of Wisconsin, Milwaukee, MI, USA
| | - K Oshima
- Department of Pathology, Medical College of Wisconsin, Milwaukee, MI, USA
| | - J P Thomas
- Department of Medicine, Medical College of Wisconsin, Milwaukee, MI, USA
| | - C R Myers
- Department of Pharmacology and Toxicology, Medical College of Wisconsin, Milwaukee, MI, USA
| | - G Stoner
- Department of Medicine, Medical College of Wisconsin, Milwaukee, MI, USA
| | - G Chen
- Department of Pharmacology and Toxicology, Medical College of Wisconsin, Milwaukee, MI, USA.,Zablocki Veterans Affairs Medical Center, Medical College of Wisconsin, Milwaukee, MI, USA
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Lin PS, Tsai S, Wallach DF, Ehrhart C. Visualization of surface topology of human lymphoid cells by scanning electron microscopy. Bibl Haematol 2015:263-9. [PMID: 1080664 DOI: 10.1159/000397541] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
We have studied the surface characteristics of human lymphoid cells with the scanning electron microscope (SEM). We obtained thymic cells by mincing thymus and isolating peripheral blood lymphocytes from normal donors as well as patients with acute and chronic lymphocytic leukemia (ALL and CLL). Prior to SEM, we purified the lymphocytes in isoosmotic Ficoll-Hypaque gradients. In addition, we examined several lymphoid cell lines in permanent culture derived from normal persons, patients with infectious mononucleosis, as well as from patients with ALL. The surfaces of most thymic cells appear smooth with only a few short microvilli. A small number of thymic cells, on the other hand, are found to exhibit many more microvilli of uniform shape and length. We could further identify lymphocytes from normal donors as T- and B-types according to their rosetting spontaneously with sheep red blood cells (SRBC) resemble thymic cells in their surface topology. However, B-cells rosetting with amboceptor--and complement--treated SRBC show greater number of microvilli. The surface morphology of lymphocytes from leukemic patients appears more or less characteristic of the disease type. In contrast, the surfaces of cultured lymphoid cells show a diversified surface topology, often with large smooth areas, very long and very short microcilli, which may often cluster in groups. These data bear directly upon techniques of plasma membrane fractionation and we suspect that the topology differences correlate with their differentiation patterns.
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Kagiyama N, Okura H, Kume T, Neishi Y, Hayashida A, Hirohata A, Yamamoto K, Yoshida K, Yang LT, Tsai W, Tsai S, Tsai Y, Liao I, Hsu C, Poorzand H, Mohamadzadeh Shabestari M, Vakilian F, Abasi Teshnizi M, Allahyari A, Narayanan SR, Jafar NS, Al Shamkhany WS, Rajappan AK, Janardhanan R, Patel K, Mizyed A, Thompson J, Rodrigues A, Afonso J, Cordovil A, Monaco C, Piveta R, Cordovil R, Fischer C, Vieira M, Lira E, Morhy S. Case-Based Session: Cases from Outside Europe: Friday 5 December 2014, 15:30-16:30 * Location: Agora. Eur Heart J Cardiovasc Imaging 2014. [DOI: 10.1093/ehjci/jeu258] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
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Krepline AN, Christians KK, Duelge K, Mahmoud A, Ritch P, George B, Erickson BA, Foley WD, Quebbeman EJ, Turaga KK, Johnston FM, Gamblin TC, Evans DB, Tsai S. Patency rates of portal vein/superior mesenteric vein reconstruction after pancreatectomy for pancreatic cancer. J Gastrointest Surg 2014; 18:2016-25. [PMID: 25227638 DOI: 10.1007/s11605-014-2635-9] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2014] [Accepted: 08/18/2014] [Indexed: 01/31/2023]
Abstract
BACKGROUND Pancreatectomy with venous reconstruction (VR) for pancreatic cancer (PC) is occurring more commonly. Few studies have examined the long-term patency of the superior mesenteric-portal vein confluence following reconstruction. METHODS From 2007 to 2013, patients who underwent pancreatic resection with VR for PC were classified by type of reconstruction. Patency of VR was assessed using surveillance computed tomographic imaging obtained from date of surgery to last follow-up. RESULTS VR was performed in 43 patients and included the following: tangential resection with primary repair (7, 16%) or saphenous vein patch (9, 21%); segmental resection with splenic vein division and either primary anastomosis (10, 23%) or internal jugular vein interposition (8, 19%); or segmental resection with splenic vein preservation and either primary anastomosis (3, 7%) or interposition grafting (6, 14%). All patients were instructed to take aspirin after surgery; low molecular weight heparin was not routinely used. An occluded VR was found in four (9%) of the 43 patients at a median follow-up of 13 months; median time to detection of thrombosis in the four patients was 72 days (range 16-238). CONCLUSIONS Pancreatectomy with VR can be performed with high patency rates. The optimal postoperative pharmacologic therapy to prevent thrombosis requires further investigation.
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Affiliation(s)
- A N Krepline
- Department of Surgery, Division of Surgical Oncology, Medical College of Wisconsin, 9200 W Wisconsin Avenue, Milwaukee, WI, 53226, USA
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Tsai M, Chan K, Chen H, Lai Y, Tsai S, Chen H, Wu Y. A Dose-Effect Relationship and Estimated Parameters for the Lyman-Kutcher-Burman (LKB) Model of Normal Tissue Complication Probability (NTCP) for Radiation-Induced Hypothyroidism. Int J Radiat Oncol Biol Phys 2014. [DOI: 10.1016/j.ijrobp.2014.05.1664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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